Increase in HIV incidence in women exposed to rape.

Naeemah Abrahams,Nasheeta Peer,Soraya Seedat,Claudia Garcia-Moreno,Kristin Dunkle,Esnat Chirwa,Shibe Mhlongo,Bronwyn Myers,Rachel Jewkes,Carl Lombard,Andre P Kengne

doi:10.1097/qad.0000000000002779

Abstract

Objective:To determine the incidence of HIV acquisition in women postrape compared with a cohort of women who had not been raped.Design:A prospective cohort study.Methods:The Rape Impact Cohort Evaluation study based in Durban, South Africa, enrolled women aged 16–40 years from postrape care services, and a control group of women from Primary Healthcare services. Women who were HIV negative at baseline (441 in the rape-exposed group and 578 in the control group) were followed for 12–36 months with assessments every 3 months in the first year and every 6 months thereafter. Multivariable Cox regression models adjusted for baseline and time varying covariates were used to investigate the effect of rape exposure on HIV incidence over follow-up.Results:Eighty-six women acquired HIV during 1605.5 total person-years of follow-up, with an incident rate of 6.6 per 100 person-years [95% confidence interval (CI): 4.8–9.1] among the rape exposed group and 4.7 per 100 person-years (95% CI: 3.5–6.2) among control group. After controlling for confounders (age, previous trauma, social support, perceived stress, multiple partners and transactional sex with a casual partner), women exposed to rape had a 60% increased risk of acquiring HIV [adjusted hazard ratio: 1.59 (95% CI: 1.01–2.48)] compared with those not exposed. Survival analysis showed difference in HIV incident occurred after month 9.Conclusion:Rape is a long-term risk factor for HIV acquisition. Rape survivors need both immediate and long-term HIV prevention and care.

Highlights

The intersecting and globally ubiquitous epidemics of rape and HIV are both partially driven by sex inequality [1,2]
Of the 1799 participants enrolled, 1019 were HIV negative at baseline and included in this analysis: 441 in the rapeexposed group and 578 in the control group (Fig. S1: see flow diagram and text presented in Supplementary content 1, http://links.lww.com/QAD/B930)
The current study shows rape is associated with a prolonged increase in the risk of HIV infection

Summary

Introduction

The intersecting and globally ubiquitous epidemics of rape and HIV are both partially driven by sex inequality [1,2]. This was demonstrated in a meta-analysis of four cohort studies included in a larger systematic review on the association between HIV and intimate partner violence (IPV) (n 1⁄4 28 studies). The work cannot be changed in any way or used commercially without permission from the journal

Methods

Results

Discussion

Conclusion